APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 by keithmurray

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									APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702                                                                                (Instructions on reverse side) PAGE ONE OF                      PAGES


TO (OWNER):                                                       PROJECT:                                                                    APPLICATION NO.:                                      Distribution to:
                                                                                                                                                                                                     OWNER
                                                                                                                                              PERIOD TO:                                             ARCHITECT
                                                                                                                                                                                                     CONTRACTOR
FROM (CONTRACTOR):                                                VIA (ARCHITECT):                                                            ARCHITECT’S                                           
                                                                                                                                              PROJECT NO.:                                          

CONTRACT FOR:                                                                                                                                 CONTRACT DATE:

                                                                                                             Application is made for Payment, as shown below, in connection with the Contract. Continuation
CONTRACTOR’S APPLICATION FOR PAYMENT                                                                         Sheet, AIA Document G703, is attached.
 CHANGE ORDER SUMMARY
                                                                                                             1. ORIGINAL CONTRACT SUM.............................................................. $             ________________
 Change Orders approved in                             ADDITIONS               DEDUCTIONS                    2. Net change by Change Orders ........................................................... $         ________________
 previous months by Owner                                                                                    3. CONTRACT SUM TO DATE (Line 1 +/- 2) ......................................... $                   ________________
                                TOTAL                                                                        4. TOTAL COMPLETED & STORED TO DATE ................................... $                            ________________
                                                                                                                     (Column G on G703)
 Approved this Month                                                                                         5. RETAINAGE:
      Number              Date Approved                                                                        a. _____ % of Completed Work                $         _______________
                                                                                                                     (Column D + E on G703)
                                                                                                               b. _____% of Stored Material                $         _______________
                                                                                                                     (Column F on G703)
                                                                                                               Total Retainage (Line 5a + 5b or
                                      TOTALS
                                                                                                                     Total in Column I of G703) ........................................................... $     ________________
  Net change by Change Orders                                                                                6. TOTAL EARNED LESS RETAINAGE ................................................ $                    ________________
The undersigned Contractor certifies that, to the best of the Contractor’s knowledge, information and                (Line 4 less Line 5 Total)
belief, the Work covered by this Application for Payment has been completed in accordance with the           7. LESS PREVIOUS CERTIFICATES FOR
Contract Documents, that all amounts have been paid by the Contractor for Work for which previous                    PAYMENT (Line 6 from prior Certificate) .................................... $               ________________
Certificates for Payment were issued and payments received from the Owner, and that current payment          8. CURRENT PAYMENT DUE ................................................................ $            ________________
shown herein is now due.                                                                                     9. BALANCE TO FINISH, PLUS RETAINAGE ....................................... $                       ________________
                                                                                                                     (Line 3 less Line 6)
                                                                                                             State of:                           County of:
CONTRACTOR:                                                                                                  Subscribed and sworn to before me this                       day of                              , 19


By:            ____________________________________________________
                                                                                                             Notary Public:        _______________________________________________________________
Date:          ____________________________________________________
                                                                                                             My Commission expires:              _______________________________________________________




ARCHITECT’S CERTIFICATE FOR PAYMENT                                                                          AMOUNT CERTIFIED.............................................................................. $
                                                                                                             (Attach explanation if amount certified differs from the amount applied for.)
                                                                                                                                                                                                                ________________

In accordance with the Contract Documents, based on on-site observations and the data comprising             ARCHITECT:
the above application, the Architect certifies to the Owner that to the best of the Architect’s knowledge,
information and belief, the Work has progressed as indicated, the quality of the Work is in accordance       By:________________________________________________Date:________________
with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED.              This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named
                                                                                                             herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner
                                                                                                             or Contractor under this Contract.
                                                                                                                                                                                                     G702-1983
CONTINUATION SHEET                                                         AIA DOCUMENT G703             (Instructions on reverse side)      PAGE   OF   PAGES

AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing                          APPLICATION NUMBER:
Contractor’s signed Certification is attached.                                                     APPLICATION DATE:
In tabulations below, amounts are stated to the nearest dollar.                                            PERIOD TO:
Use Column I on Contracts where variable retainage for line items may apply.                 ARCHITECT’S PROJECT NO.:

   A                    B                       C                 D                E             F                         G                        H            I

  ITEM       DESCRIPTION OF WORK          SCHEDULED              WORK COMPLETED              MATERIALS          TOTAL                %          BALANCE TO   RETAINAGE
   NO.                                      VALUE                                            PRESENTLY       COMPLETED             (G ) C)        FINISH
                                                          FROM PREVIOUS        THIS PERIOD    STORED         AND STORED                            (C - G)
                                                           APPLICATION                         (NOT IN         TO DATE
                                                              (D + E)                          D OR E)        (D + E + F)
G703-1983

								
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